Provider Demographics
NPI:1598208803
Name:TAYLOR, MATTHEW ALLEN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CHALLENGER WAY STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5423
Mailing Address - Country:US
Mailing Address - Phone:707-565-4797
Mailing Address - Fax:
Practice Address - Street 1:2227 CAPRICORN WAY # 27
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5478
Practice Address - Country:US
Practice Address - Phone:707-565-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135285106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health